Q&A: Burn Out Your Therapist?

Answer: This is a tricky one because I can’t speak for all therapists, but I’ll share some thoughts. Technically speaking, parents should love all their children the same and professionals, who are paid adequately for their time, should give each client equally enthusiastic service. The problem is that humans are not robots and we experience each relationship differently.

Here is the good news:

The worries that seem most dire to you are probably not the ones that have the most impact on your therapist. For example, If a therapist responds well to early hints of neediness and attachment, then those qualities, which are so “disgusting” and “shameful” to the patient, are actually not a problem for the therapist. These feelings of disgust and shame reflect toxic attitudes that were internalized long ago from unloving and abusive caregivers. A therapist who felt that way about patients would probably not go into the profession and would certainly not last long doing in-depth psychotherapy.

But it is more complicated.

As has been chronicled so many times on these pages, there are therapists who can’t handle neediness and attachment. Most of those don’t present themselves as ready to do deep psychotherapy. They are more likely to identify as cognitive-behavioral therapists or to espouse a brand of therapy that does not emphasize a long-term deep relationship. Unfortunately, there have been cases of misunderstanding or mismatch where the patient couldn’t know that the therapist would reject or even punish attachment. This has happened more often with trainees, who might have the temperament to be able to handle a deep relationship, but the supervisor or the clinical director could not.

The best advice I know is to test the waters with a trial balloon or two to see what the reaction is. A therapist who competent will welcome a patient who wonders what is OK in the therapy. One who is ready to do the work will communicate willingness and encouragement. One caveat is that fear and shame sometimes cause patients to give such quiet hints that the therapist won’t notice or get what is being asked. It is important to be direct. I would recommend softening the question by using more abstract language. “I am wondering if this is a treatment that encourages talking about feelings towards the therapist?”

“Borderline Personality Disorder”

I don’t usually use that term or think well of it. Judith Herman wrote an important book, Trauma and Recovery, opening the field’s eyes to the fact that borderline usually means trauma. However, there are patients whose relationships tend to be chaotic and go from hot to cold very quickly. Often there are crises so frequent, intense, and dire that dealing with them distracts from the flow of the therapy. Perhaps most important, the therapist can be the best therapist one day and the worst the next.

Some therapists are more able to handle the crises and deal with the criticisms in an non-defensive way than others. Usually over time, therapists self-select away from this kind of patient if they have too much trouble. Here is where one of the therapist’s most important therapeutic roles is to be a “rock on the shore, battered by raging storms.” Simply by not being too reactive, the therapist brings calm and containment to a psyche in life-and-death turmoil.

One thing that makes a therapist able to do this is a perspective on what is happening. Understanding takes much of the threat out of the interaction. Another useful component is taking some pride in being able to help people who are not easy to help.

A Special Conundrum

I have written elsewhere about a special situation that happens sometimes. The patient chooses a therapist who has the qualities of acceptance and caring that were missing long ago. As the therapeutic relationship deepens, the patient begins to identify what seem to be negative intentions in the therapist that have been “transferred” from the past. In other words observations about the therapist are mis-perceived as sure evidence of say—of not caring. Now, this therapist does really care, and was chosen for that quality. Furthermore, the therapist takes a lot of pride in being a caring person. So when the patient begins to criticize the therapist for not caring, it is hard for the therapist not to feel offended and get defensive. After all, the criticism falls right where it hurts most. And, to make matters worse, the therapist’s involuntary defensiveness confirms the patient’s worst fears. Hopefully, before the investment both have put into this relationship is thrown overboard, the therapist figures out that this is all a misinterpretation and is able to help the patient see it.

When the work is taxing and difficult

Yes, there are times when every therapist has a “bad day in the office.” That is to be expected and it is why therapists need their own support system outside. And it is true that some patients are more “high maintenance” than others. It is the therapist’s job not to let any patient be the cause of “burn out.” That might mean restricting contact between sessions or not being willing to discount fees. It might mean, wisely, referring a patient out in the beginning of therapy. It might mean bringing in outside resources such as a day program or adjunctive therapy. Somehow, the balance of plusses and minuses in every therapeutic relationship will need to average out in the positive for both sides. If this balance is getting hard to maintain, it is the therapist’s job to bring this problem into the therapy and see that it gets solved. Something must be done to repair ongoing negativity. A therapist who dreads each session is as unworkable as a patient who dreads each session.

Two Basic Ethical Principles

The structure of therapy is that the patient pays for professional services that are for his or her benefit before and above all else. Within this framework, one ethical principle subsumes all others: Therapists should not make or imply promises they will not be willing or able to keep. Within these principles, is there room for therapists and patients to have a good time together? Absolutely. Laughter, warmth, enjoyment of mutual connection, pride in success, and even a feeling of power are all positive feelings that can happen for both participants, in a therapy that continues every session to meet these two ethical principles.

37 Comments

I was re-traumatized by a therapist with poor boundaries. I don’t have words to tell the devastation her inability to self-regulate caused in my life. I’ve been in treatment for almost two years trying to get past this so I can even talk about the original issue that brought me to therapy, to begin with.

I’m not sure if this post makes me feel better or worse. I think I was in this exact situation with my ex-therapist,and I worry about the exact same things.

I saw the same (and my first) therapist for a year and ten months. About three months in, he said he thought I had borderline personality disorder, but said that he had lots of experience dealing with it, and didn’t suggest that I start seeing someone else at that time. Then, one day, he came into a regular session and told me that he thought he wasn’t helping me and that it would be best if I find another therapist. He didn’t give me any warning, no referrals, and cut off contact with me immediately. I was and still am absolutely heartbroken and traumatized by what happened. I’m not sure why I wrote all this out, or if it even applies directly to the post. I guess I worry a lot that I drove him away. I’ve tried a couple of therapists out since he terminated therapy, but I feel like I don’t even know why I’m going or what is supposed to happen in therapy. If whatever I was doing with the old therapist was wrong and, in fact, so wrong that it caused him to send me away, then I clearly don’t know what is supposed to be happening in therapy. I also feel like I am wearing a scarlet letter indicating that I am a difficult client. It is very shameful for me to tell prospective new therapists about what happened with the old therapist. I am sure they will send me away based on the past rejection.

The saddest part is that, even though I am not sure if maybe my old therapist was a bit unethical in the way he ended things, I still would give anything to get to go back to him. I am having all these terrible, sometimes unbearable, feelings, and I only want to talk to him about them because he was the only person throughout my life who I told everything to. He was the only person I could cry in front of. Maybe I’m being overly dramatic, but the past four months have been the worst of my life.

Again, I’m not sure if this is really a comment on the post or my own confession. Regardless, I think the response to the question posed is accurate, and I am glad that this website exists because at least it lets me know I’m not the only person who can relate to the topics covered.

Your experience mirrors my own, I did find both a male and female counselor, both have believed and supported me. It is very difficult to work through the feelings about the old therapist. What he did was wrong and unethical. I understand feeling the need for an explanation. He wasn’t able to be honest with you during termination, it’s highly unlikely that he would put your best interests ahead of his own now. As painful as it is to accept this person’s caring was not genuine and he was not willing to put your needs as a client first.

My T. just called me a few hours ago, he thought we have an appointment and i did not show up but we don’t have any today, and he acknowledged his mistake.
I wonder what happened. I can’t help wondering. Is he confused? Am I too much? Does he face difficulties in his private life?
I was delighted to hear his voice and to think he is thinking of me, and we took the opportunity to check our dairies and plan the later appointments, but I already worry too much about our relationship –all sorts of things— and this just adds fuel to the fire.
It would be terrible if this is burn out, because of me.
How it would add to the shame around my neediness!
To the shame about me not being good enough, not lovable.
I have been very hot and cold with him.
I sometimes feel it is overwhelming for him. Last session we had a kind of argument and I felt I was losing him and got fearful and was devastated, but then it was all my projection, he said he was ok having an argument with me, to him it was not the end of the world.
It sounded like the entire world is not what I think it is.
It felt wonderful.
But was he telling truth?

Is he the “rock on the shore, battered by raging storms”?
If he is in pain it hurts, I want to help him.
But then that’s no more about me.

Partial response: Regarding adjunctive therapy, for intrusive life crises, day hospital can be good. For powerful transference, Yoga, body work, self-help such as al-anon could be helpful. And I hope this blog can help a little. JS

The struggle is real. You’ve just reminded me how fortunate I am to have found my therapist. She accepts, normalizes, and contains my rages, projections, neediness, and ever so shameful attachment to her She’s passed all the “trial balloons.” In the “moments of change” where I once again question her caring, this will be my go to post to help remind me how cared for and accepted I am. Thank you once again!

As a nurse myself of 48 years I’m sure it’s very possible for a therapist to burn out. Especially after 23 years of therapy with someone with mpd / not integrated.
And I think if the therapist is burning out with one client who has many alters perhaps she or he should have asked for / or accepted guidance from someone with more clinical experience – (especially if they have never worked with anyone with DID).
And if the therapist is needing to discharge that client because they are burning out I think they should have the courage to try to do that in a way that is kind and without malice. Or at the very least have the professionalism to discharge with an appropriate referral in place if that client requires further treatment.
I will never seek out the help of another therapist for however long I have left to live . I’ve been in therapy since I was a kid. I’m 69 now. So there isn’t anything I haven’t been through with therapists ……Not until I was totally and cruelly abandoned by the most loved and trusted of therapists who had helped me to become my most healthy self up until one year ago.
Then as she burnt out – she brought me to ashes with her …

Hi Sharon,
Thank you for sharing your experience. I live with DID, too. I’ve had it since I was four or five years old, but I didn’t get dxed until I was in my mid 20’s.
I have nothing smart to say about your experience. I just wanted to send you my support your way. Although I don’t know you, I’ve been rejected by the most trusted people in my life, too, and I can imagine the pain you must be in. I know it’s easier said than done, but I hope you take a gentle care of yourself. I am sending you LOTS of healing thoughts only if you allow me.
Echo

Hi Echo thank you for your awareness of my pain over the loss of this therapist .She went from being the most trustworthy person I had ever experienced in my life to being just another perpetrator who set me up for the kill. Your kind words and validation mean more to me than you know. Maybe we could somehow stay connected . Since DID isn’t something that comes up in casual everyday conversation it would be great to talk with someone about the struggle. I don’t know if this is the place to do that but – just think about how we could continue the conversation. No pressure. And if I don’t hear from you again I will be forever grateful for your reaching out to me on Dr Smiths blog.

Hey Sharon, a good place to check out is http://www.discussingdissociation.com
Sorry to hear about your problems with the T. Our T is sick and in the hospital. Not the same, I know, but hurting and missing him and worrying and wondering if I caused it, etc, makes us feel very vulnerable and sad. We hope you start to feel settled and better soon.

I just want you to know you are not alone. I don’t know if that helps. thank you for writing. It helps me to know I am not alone with the feelings I have of having been abandoned. I agree with what you say.

Wow, you sure are prescient with your articles. Either that or problems in therapy are so universal that everyone is constantly having the same issues.

While no one would accuse me of being a high maintenance patient, I am a difficult patient–highly resistant and really not making much progress. My therapist seems pretty frustrated. He’s constantly talking about how long therapy’s going to take if I continue approaching it the way I do. Last time, he said something to the effect of “you still don’t trust me after being here with me for so long.”

While I’ve been seeing him for approximately six calendar months (started in mid-May), during those six months, we took at least 12 weeks of breaks (two 3-week breaks and one 6-week break). So, in reality, I’ve only been seeing him for 3 months. We’ve had 18 sessions so far.
One 3-hour session; 17 90-minute sessions = 28.5 hours. Does that seem like a long time to you?

Anyway, it just seems like he’s trying to get rid of me. Maybe it’s negative transference, or maybe it’s real. Hard to tell.

During our last session, I expressed (albeit indirectly) some of my fears regarding therapy and where it’s going. I had been thinking about something you wrote in one of your books–I think it’s Getting the Most Out of Your Therapy–that the worst thing that can happen from trying therapy is nothing. I had been thinking about writing you to say that, given the horror stories I’ve read both in the comments here and on this therapy forum I frequent, I’d say that the worst thing that can come from trying therapy isn’t nothing. It’s serious injury, even trauma, to the patient.

I told my therapist exactly what I wrote above–talking about it in general terms. While he agreed with me in principle, well, he’s not an idiot, and I don’t think he enjoyed having my doubts directed at him in that way. Earlier in the session, I also flat out told him that I didn’t want to work on some of the issues he wanted me to work on because those things just didn’t seem all that important to me. While he maintained a professional demeanor and didn’t seem overtly defensive, I could tell that he wasn’t thrilled with any of this.

Not wanting to go into Thanksgiving break with a partial rupture in the relationship, I wrote him an email telling him just about everything. (I tempered the language a bit so as to not sound completely insane.) I went through several iterations of that email, and I was proud of the end product. The first few versions contained irrelevant content, placed blame on the internet and other people, and contained veiled and passive-aggressive criticisms of him. In the end I got rid of all of that stuff. I took responsibility for my feelings and explained that if I overreacted to things he said or did it was really negative transference. (I didn’t use the phrase negative transference but explained it in more words.)

We’ll see what comes of it. Sometimes I feel like I’m doing all the work in therapy (although my therapist would vehemently disagree and say I’m refusing to do any work).

I’m thinking about telling him, next time I see him, that if he wants to get rid of me, he should do so now. The longer he waits, the worse it’s going to be for me. If he doesn’t think he’s going to be able to go through this process to the end with me, maybe we should just end it now.

In many ways, it’s already too late for me. If things end poorly, I’m going to have to spend God knows how long with the next therapist–assuming I even find another acceptable one–working through the pain and injury caused by this one.

This lady who posts on this other forum has a good analogy: she said she had a slight limp before starting therapy, and, now, after five years of therapy, she’s paralyzed and can’t walk. I really hope that doesn’t happen to me…

Oh, my. I didn’t anticipate so many terrible stories. Kayla, I was obviously wrong to say “the worst thing that can happen is nothing.” Please tell me where, so in the next edition I can change that. I hope we can all think together about how to prevent such disasters. This is a real public health problem, and neither licensing, nor professional societies seem able to deal with it. Jeffery

It looks like my memory was not entirely accurate. What you said was, “[t]he most common risk is that nothing happens,” which is accurate. You go on to say that “the next greatest risk is a therapist who is not equipped to deal with strong feelings or challenging reenactments.”

Sorry, I should have re-read what you actually wrote before posting. Had it been an actual critique, I would have been more careful, but I was only describing idle thoughts I’ve been having recently. But, as you can see, I have selective memory issues.

I do remember what you wrote about the commenter who was terminated by her therapist after eight years of therapy and how that disaster should have happened eight years earlier. I had that admonition firmly in mind when I started therapy a couple months ago, and I’ve been wondering how it is that I find myself in this situation now. How did I end up with a therapist who might be a terrible fit? Didn’t I know not to let this happen?

I think it happened because it’s generally impossible to know if someone is a good fit during the initial stages of a relationship. There’s simply no good way to divine whether someone is going to be a good therapist for you before the relationship deepens and problems arise. There are ways to minimize the risks of ending up with the wrong person, but that, too, is something that must be learned through trial and error. It’s a lot like dating, except far riskier from the patient’s perspective.

And you don’t have to be an incompetent or unethical therapist to unintentionally inflict harm on a patient. Once you get to a certain point in a relationship, there’s pretty much nothing a therapist can do to avoid a terrible outcome. For example, if my therapist determines, in his professional judgment, that he can’t help me (a perfectly reasonable determination), what should he do? Should he continue seeing me and hope that things will miraculously work out? Or should he refer me to someone else?

The first option simply postpones the inevitable, and it’s also ethically dubious. The second option inflicts immediate injury on the patient. As soon as he tells me I should consider seeing someone else (a much milder approach than outright termination), I’m going to be devastated. There’s nothing he can say that’s going to prevent me from being devastated. No reason. No explanation. Even if I understood his reasoning perfectly, I’m still going to be devastated.

I don’t want to give people the impression that my therapist is a bad therapist. When I’m complaining about him, I’m focusing on the negative. The picture I paint is biased. I feel this anger towards him that just won’t go away. A lot of my writing is fueled by that anger.

He’s really a good therapist. And I’m sure he’s been a great therapist for a lot of people. Everything I’ve ever read about him indicates that he’s a good therapist and a good teacher. His students love him. They loved him 20 years ago, and they love him now. I was careful to pick a good one this time.

But he just may not be the right fit for me. And it’s not his fault. It’s really not anybody’s fault.

I don’t know how licensing bodies and professional societies can possibly deal with this.

I think one thing they could do is better training (something I am working on). My understanding, from talking with and observing mental health professionals, is that they don’t get a lot of training in how to handle difficult terminations – and probably ruptures – and setting boundaries is often about protecting the therapist (a reasonable protection, but it is also about protecting the client which often isn’t conveyed in my experience). that’s what I’m thinking today anyway. I’m working on this – a work-in-progress.

“A therapist who dreads each session is as unworkable as a patient who dreads each session.”

I’m sad to say that I’m one of those patients who dreads each session. Part of me really wants therapy, but another part of me is battling against it very hard. I can’t seen to get comfortable with my therapist even after a year and a half. I’m also not very direct and have a hard time talking about anything. I have a history of violent trauma and sexual abuse as a child, but I can’t tell him about any of it. I fear that he’s getting fed up with me, but I think I would have the same problem with another therapist, too.

Jeffery you are so right to describe these awful traumas as a public health problem. If therapy was a drug there would be adverse effects all over it. I am so fortunate to have the most wonderful therapist but I have said to her and posted here before that therapy should come with health warnings, people think they are going into it to feel better through talk but the reality for me and many others here is pain, that can become bodily as well as emotional, real attachment issues and terror of abandonment by the only person you really feel knows and understands you. Sharon’s last comment cut me so deeply, I often feel that I exhaust my therapist but if we both went down in ashes I couldn’t survive. This must be your most difficult post to date, it’s raised such important issues for clients and therapists. I hope therapists read these posts too.

The way I found my therapist was so totally random– basically I took first name on the Google list. Even then, I was only going to see him so he could “fix” my 17 year old who was having some issues. I was just gonna see him for at the most 4 times and then move on. Now, 2 years later… he did help me make changes in my son. However, he also made absolutely life-changing differences in my life. He helped me see things in a way I’d never thought of before. I never realized how incredibly fortunate I was to have him be my therapist until I read some of these posts.
As I have shared before on articles by Dr. Jeffrey, I have also become very attached to this therapist– as a father figure. But I now think it is probably time for me to move along. In fact, we have a “state of the union” meeting on December 4th to discuss this very thing–at my request. One of the main reasons I feel I need to do this though is because I am pretty convinced he’s gotta be sick of hearing me go over the same issues over and over. It is kind of embarrassing that there are some issues I just can’t get past. However, I also think I am holding onto some things so I don’t have to move on– away from him. That’s me being completely honest– and I haven’t even been honest about that part with him.
So anyway I am glad he’s the kind of therapist that he is, but that in itself creates issues. I also just realized this may not be the correct article to post this under; I probably should have gone back to the attached to your therapist one.

TLC, This is the place. I am hoping people place comments in the most recent post, so the community knows where to follow, even if off the topic. You raise a very interesting question. My ambition is to do the next Q&A post on the question implied: “When is it therapeutic to let go of my therapist?” or something like that. Please don’t let me forget this. JS

i’m looking forward to reading this upcoming post as i am someone who had to make this decision 3 times over in my many years of therapy, the third time, although i think it was the best match, my attachment issues were not addressed & i found myself becoming increasingly self-destructive and needed to make the call no matter how difficult & leave therapy behind. although i’m someone who has made great progress alone in the years following that last go at therapy, the attachment issue never goes away & still causes me pain.. i am 52 now & the cost for therapy is a luxury i can no longer afford.. any advice on how i can keep working on the issue alone would be helpful, as would your opinion on the constellation of symptoms now commonly being thought of ‘childhood emotional neglect’ (re: jonice webb & her book ‘running on empty’) which seems to encompass the attachment issue as well.. thanks,

I read the posts about the terrible pain people are in because of abandonment and rejection by therapists. It seems to me, and I know it’s hard for people to hear, that they are still depending on the therapist to calm them. I know that if you were neglected/abused as a child, you do not have a foundation on which to build your life. It seems to me that all of us who have persisted in trying to get another person to soothe us, maybe do so because we don’t know how to soothe ourselves. We feel better when we talk to that special someone, (the therapist), but when we have to leave, bleeding from talking about difficult and painful subjects, we don’t really know how to care for our own wounds, and so we live in virtually unbearable emotional pain and out-of-the-box anxiety until the next session with the therapist.

I know these things because I have seen about 70 different mental health professionals in my life, most only 2 or 3 times, but 5 of them for up to 2 or 3 years. Those all ended disastrously, but I managed to salvage myself by learning DBT (dialectical behavior training). I bought a workbook on DBT, and studied and practiced it each time I came home in terrible anxiety and emotional pain from having to leave the attention and safety of the therapists office. I have written about this before in Dr. Jeffrey’s other posts. It is really hard at first to do DBT, because you have to learn to do for yourself (soothe and regulate emotions) what you so desperately want someone else (in this case, the therapist) to do for you.

DBT is a way to learn to deal with overwhelming emotions. It is a way to learn to calm your emotional storms and learn to soothe yourself, just like you would have done if you were cared for as an infant and young child. But since you weren’t, this book actually has written instructions about how to deal with overwhelming emotions, like those you have when you do not have the therapist there to do the soothing. It teaches you how to build an emotional foundation for yourself.

I still read this post because, even though I consider myself to have graduated from therapy, I still experience feelings of loss for my last therapist. I sometimes still feel the pain of neglect and emotional chaos during my childhood. I also feel empathy for others who write on this blog. I now see attachment disorder as a failure to be able to self-soothe. It’s like the child who cries when his parents go out for the evening – he learns to so something soothing for himself until his parents return. He learns to interact with the babysitter. So too, those of us who experience strong attachment in therapy, because it’s an adult who cares about us, have the task of learning to soothe ourselves when the therapist is not there.

I know different things work for different people. But Jeffrey, I wish you would do a blog on techniques for learning to self-soothe. I feel like it would help those of us who have experienced so much pain and emotional anxiety, wanting the therapist to do it for us because we didn’t learn how to do it ourselves.

I feel like I have a life now: I’m working toward some employment goals, and I have an inner life that is mostly peaceful. I do not think about my past therapist all the time like I used to. Sure, I think about him a few times a month, but when that happens, I ask myself, “What do I need? What is the most loving thing I can do for myself right now?” And then I do that thing. I used to write emails to that therapist when I was stressed. I’m happy to say that I haven’t written in 3 months, and I no longer feel triggered to write him an email when the going gets stressful. DBT has really helped me.

I know everyone is in a different place, their own place. So DBT might not be what everyone wants to try. But I think a post on ways to self-soothe when you are away from your therapist would really help. I wish I had learned to do DBT so much earlier in my life. I’m 55, and it would have saved me many years of agony and a suicide attempt.

I feel for each person who writes here of their struggles and intense suffering in therapy. I’m suggesting that learning self-soothing techniques could really help calm the storm when you are not with your therapist and so they can soothe you.

If anyone is interested, the workbook I used was “The Dialectical Behavior Therapy Skills Workbook”. The authors are McKay, Wood, and Brantley.

I hear this and want to cry. It is hard to hear. Just because I’m dysregulated, just because I don’t know how to soothe myself yet, just because I’m learning how to soothe myself, doesn’t mean I am depending on my therapist to calm me. and IF I am, it is part of the therapist’s job to help me learn to do that on my own. It’s a natural transition. What we are often there for. I cringe when I hear people criticize those for not doing what they are working very hard, perhaps in small steps, to learn to do.

I do think your point about learning to self-soothe is helpful. The recommendation of DBT is useful. Many people have been helped with DBT. I have recently discovered the polyvagal theory (Stephen Porges) and find his stuff even more useful, but not as extensive, and the two things do not contradict each other. I would suggest people might want to consider DBT as another support, and learn the applications of polyvagal theory (which also helps explain what is happening physically when we are anxious or dysregulated, in a way that is very helpful to coping) but not because of their relationship with their therapist.

This was such a helpful post – thank you! It helped me broach the ‘A’ subject (attachment!) with my new therapist, and even though she normalised the ‘D’ subject (dependency!) I still feel a lot of shame about it which she is more than happy to work through.

She suggested we move to twice a week therapy, which is a big relief for me. I feel a bit like a ‘serial attacher’ as I’ve had strong positive reactions to teachers and therapists in the past. This time it’s being recognised calmly and professionally and I’m feeling more at ease with it, less like I have to hide it and feel guilty, crazy and isolated.

Reminder. Just because this is really weighing on my mind. How do I know when I need to move on?
I know i am further ahead now than I was when I first started meeting with him? I know I’ve met some of my goals. I know there are goals I may never achieve. I know there are still things I need to address.
BUT…when is enough?
Sometimes…often times…I think I just keep going because if I didn’t I would miss him soooooo very much– I am so attached to him(even though he’s only about 15 years older than I, I still feel like he’s very much the dad my own dad never wanted to be).
Also, the thought of not going to him makes me feel so anxious that I can’t stand it. What if I back slide– I do it the time, even while I am still seeing him.
I question myself all the time, am I creating problems so I can keep going. But yet it also seems like there are many things that are unresolved in my brain. If I just knew I could keep going for the rest of my life without judgement, maybe I wouldn’t do this.
I’m not this world by myself. I have a husband, children, etc. but I can’t stand to think of moving totally away from my T.
Ironically, I fought the whole therapy process tooth and nail. I started out only allowing myself to go once every 6 weeks. Then nothing was working and he said he wanted to see me 1 time a week. I fought back and said every other week. But then decided every week was okay, and now I am so fricken attached. I think I knew that’s what would happen. I think I am a “serial” looking for father-figure person.
I feel guilty for continuing to go if I really shouldn’t anymore, but that totally gets pushed aside when that kid in me says, screams really, STAY!!

so here’s a question i’ve been meaning to ask for a while. are clients supposed to be careful and avoid saying anything that may upset/annoy therapist or can one be open, bold, direct and honest (without being obnoxious) to get point clearly across. can one express dissatisfaction, the feeling of not meeting expectation or would this put therapist on defensive. is the therapist equipped to take criticism and understand the clients frustration or does the client need to be careful of what one says to protect the therapists feelings. i truly am exasperated because in considering my T’s feelings i’m not expressing my dissatisfaction and growing more frustrated and resentful towards my T everyday. My husband thinks i’m overwhelming my T and he doesn’t know how to handle me. i tell my husband he is a therapist and should know how to handle all types of situations and personalities, if he can’t then he shouldn’t be a therapist. I assure you, I’m not a rude person, i’m just very assertive and direct to avoid wasting time; some friends consider me funny and even charming at times. i feel i have gotten very little feedback/help on the issues i wasc seeking help with.

Jeffery asked me to post this here instead of an earlier post because this is where current activity is centered.

I’ve been in therapy for just 3 months and I don’t think I’m quite attached yet, but I’m not sure and honestly, I’m terrified of it. I definitely have a bit of the come here/ go away dynamic going on. I just don’t want to be too needy. Why would I want to put myself into a relationship where I can’t function when my therapist goes on vacation or where I can’t stop thinking about him? This sounds scary and maybe unhealthy. I happen to be in the medical field and have started having random flashes of thoughts of my therapist contracting a serious illness ( I don’t even have these thoughts about my own family members), so I don’t know if that means I’m getting attached, or maybe it’s just a sign that I’m afraid of the potential for attachment. Also, in my line of work, I guess I’m used to taking care of others, so being the one asking for help feels very unnatural and uncomfortable. I should mention that my therapist is very kind, empathic and non-judgemental, I just don’t know if that’s reason enough to trust him. When I’ve mentioned these concerns to him, he says something about how we haven’t known each other or long and “of course you’d feel that way,” which is nice and all, but I just don’t know what to do with it.

I would love some guidance here; perhaps some reasons why it’s ok to stick with this despite feeling so uncomfortable. Thank you!

Dear Lois, I can’t tell, but simply thinking about attachment to your therapist, as well as thoughts of the therapist’s contracting a serious illness, could certainly be signs that this is an issue. For a patient to hold back their real thoughts for fear of disturbing a therapist is not how therapy is supposed to work. The result is a very real emotional barrier between the real patient and the therapist. In fact, there is research showing that the repair of breaks in attunement is one of the things that makes therapy work. So it is always a good idea to move towards full openness. Unfortunately, we have seen in these pages how often therapists are not up to the job of handling intense interactions. I have often said that I think it is better to test the mettle of your therapist early, before you have made a huge investment. I don’t mean not to be tactful, but to introduce the fact that there are feelings that need to be discussed. If the therapist doesn’t handle that gracefully, then it will be hard to do in-depth work on the kinds of issues discussed in this blog. As I have said before, I wish there were a better way to screen therapists. Actually in one of my other activities as Newsletter Editor of SEPI the Society for the Exploration of Psychotherapy Integration, in our forthcoming (January 15) issue, we are focusing on how research needs to look at what makes some therapists better than others in general as well as with specific patients and situations. This is a neglected and under-supported area of research, but greatly needed.

Thank you for your response, Jeffery. I think you might have combined your response to my question (Lois123) and the the question posed by Seven (just before my question). It was Seven who was concerned about offending her therapist. That is not a concern of mine. Thanks.

“I know that I am not ‘done’ with therapy because the strength of my attachment indicates a past wound that needs to be healed.”
The above is quoted from another post on different article on this site.

I just read this and thought…
Is this one of the indicators to help you know if you are or are not finished with therapy?
Is this true?
If you are still hung up on your therapist are you not yet ready to move on?
I had a conversation with my therapist this week. I started it by simply stating the amount of time I’d been seeing him– about 2 times a month for about 2 1/2 years. I asked him if that was too long. He knows I see him as a “dad”, I’ve shared this with him. He said he is not the one who is going to terminate our sessions. He said that unless I develop an unhealthy dependence on him, and he said he did not think I had, he will not be the one to stop the sessions. It would be up to me. I am always the one to initiate the talk of ending the therapy– I actually hate that I feel attached to him at all. Why do I hate that fact so much? It feels so embarrassing. I hate that I feel that someone needs to help me at all. I usually pride myself on my independence and here I am feeling like I need him. Sometimes I think he has forgotten my feelings about him.
This last time he stated that he thought that what we were doing in our sessions was helping me get to my goal. But it seems like everytime I feel like I resolve one thing I see or he sees another that needs addressing. Or am I just wanting to address things that normally I might figure out on my own so I don’t “lose” him. I often feel like I am getting to be a nuisance and sometimes I really want him to just say– you’ve got this, kiddo, move on. But then I at times that thought make me feel great angst… And he says he doesn’t do it that way anyway.

(Apparently, I am a dog with a bone on this one…I really need/want to hear thoughts on when it’s time to call it quits. And plus, you did ask for a reminder.)

TLC, Thanks for the reminders and for your persistence. I have this on my mind, even though too many other things have intervened. Each time I think about the question of leaving, I think of how children let go (and don’t let go) of a parent. Some have more trouble, especially when things haven’t been so good. Others let go more easily. Overall, kids do it very gradually over time, to the point where they feel more engaged with their outside life for more of their time. In my experience in therapy, that may take a lot more than 2.5 years. I guess the question might be what is making the attachment still feel fresh and insistent. I recently read something about psychodrama. If the attachment were a character, what would it say? That might point to why it is holding on, and what work might be done to allow a transition to outside attachments. Is it anger work? Grieving work? Or is it a sense that there is just some more holding that needs to be absorbed? Maybe there are other reasons, too, but It would be interesting to hear the attachment’s view. JS

Dr. Jeffery-
It seems like you are answering my question with me needing to answer a bunch of questions. Sometimes I really do just wish that someone (even you) would just be straight forward with me about what next steps should be. Like I want to know how I know I am done, like if I can check off numbers 1, 2 and 3 on the checklist I am good to go. Am I explaining that right? I just want someone to flat out tell me exactly what he thinks is going on with me. I get tired of how my therapist makes me reason through things and come up with my own answers. I know that this is probably the way clients make the best progress, but sometime I just want someone to cut through all the BS and tell me what he really thinks. My therapist been a therapist for a very long time and he’s been seeing me for a long time, so can’t he just TELL me if I am ready to move on?

Your question of what makes the attachment so fresh and insistent, is a good one however. I think it is still there because I can’t really address it. The people who may have made me feel this need for this attachment are no longer on this earth for me to talk to. Although I have come to understand the reasons for my need for this type of attachment, and this does help, I can’t seem to let go of the hurt they caused me. Ironically, I still continue to think that I have overreacted to their treatment of me, and it all makes me feel pretty guilty. Am I angry? Am I grieving? Probably both, but I keep thinking that after this long I should be over it, and then I just get angry with myself for not being able to be the kind of person who can get past it.
I do very much appreciate your answer and I will continue to think it through to see if I am enlightened at all. Thinking of attachment as a character is an interesting one. I am not sure if I understand it correctly, but I will ponder it because it is intriguing. I’ll let you know my thoughts if I have any, and then I will let it go.
TLC

Hi TLC. You will get there. I thought that I would never, ever leave therapy. And in my life I have seen at least 70 different mental health professionals. But for the last couple of years, my attachment problems have lessened. DBT is one thing that helped me become able to do for myself what the therapist was helping me do. It feels like you are not ready to feel the enormous intensity of grief over the loss of what never was with your Dad especially. You haven’t written about your Mom, so I don’t know what she was like. Your therapist provides soothing, but when you learn to soothe yourself, either by emulating him to yourself, or by developing your own methods of self-soothing, your attachment problem will lessen. Part of learning to soothe yourself is so that when you experience the intense grief and sadness over the way your Dad was, you have some way to help yourself feel better if no one else is around. It sucks at first to do this, because it’s the opposite of what you feel you want: which is for the therapist to be there to talk to. If you practice distress tolerance and self-soothing (two things DBT teaches), I think you will learn to do more for yourself what your therapist is helping you do now. For me, my strong (extreme) attachments were a result of not knowing how to soothe my emotional pain, because my parent wasn’t able to help me learn how to relate and regulate my emotions by soothing me when I was an infant/toddler/child/teenager/young adult/adult.

The emotional pain of that is horrible, and at times seemed like more than I could bear. You don’t have to feel your pain all at once. Feel it little by little. Lean into the feeling, as Jeffrey likes to say. That means to pay attention to where you feel the feeling in your body, so that you can breathe and actually feel the feeling. It will get better. I promise. I don’t know if you are artistic, but if you are, you can try expressing your feelings that way. I let my inner child write and draw with crayons sometimes.

If you like yoga, that is a good way to get to know your body and so you become more aware of where you feel your feelings, and the breathing is good for helping get through the tears of grief.

You might be afraid because you want your therapist to soothe the pain of your childhood, and in a way, he does. But in the end it’s only you who can do this, and you do it by feeling in your body what you feel, and experiencing it and expressing it for yourself, and finding ways to soothe your distress.

One way to address your conflict about your dependence on your therapist is to ask another question. How is the critical voice in your head helping you? It might seem like it is causing you a lot of distress, but in some way it is trying to help you. Ask that voice how it is trying to help you?

You seem like a cool person and I hope that by sharing some of what I have learned from my struggles that I spark some ideas for you to move forward in yours.